MEMORY AND MEMORY IMPROVEMENT

Dennis Kelly, Ph.D., Neuropsychologist

Traumatic Brain Injury ProgramMadigan Health Care System

Washington TBI Conference28 April 2011

Sample Topics to be Covered• How does information get into memory?

• Why do I forget things?

• What are some general approaches to memory rehabilitation?

• What specifically can I do to improve my memory?

MEMORY STAGES

• Encoding (Input)

• Storage (Short-Term and Long-Term)

• Retrieval (Output)

Memory failures can occur at any of these stages.

TYPICAL MEMORY “FLOW”

Sensory InputShort-Term

Memory System

Consolidation

Permanent Loss due to Interference, Disuse, or Neural

Shock

Long-Term Memory System

Episodic (Autobiographical)

Semantic ( Facts & Knowledge)

Procedural (Motor & Skill-Based)

Temporary or Permanent Loss due to Significant

Illness or Injury

Repetition Improves Retention

Short-Term vs. Long-Term Memory

STM :• Mostly auditory encoding

• Retained for a matter of minutes

• Highly susceptible to interference

• Limited storage capacity

LTM :• Semantic encoding

• Can be retained for years

• Less susceptible to interference

• Large storage capacity

Example of a Semantic Network in Long-Term Memory

AnimalLiving Thing

Plant

Mammal Bird

Dog Lion Bat RobinPenguin

Red Breast

Wings

FLIES

CANNOT

ISIS

IS

IS IS IS

IS

IS

HAS

ISHAS

HAS

TreeIS

IS NOTCAN LIVE IN

HAS

IS NOT

WALK ON 4 LEGS

“MEMORY” IS A GENERAL TERM WITH SURPLUS MEANING.

People often report problems with memory that actually are due to other things, such as:

• Sensory limitations• Sleep disturbance• Not paying attention• Physical pain• Emotional distress• Drug and/or medication effects

IF THE PREVIOUS OBSTACLES ARE REDUCED, YOUR MEMORY WILL

IMPROVE.

Memory is Not Perfect –Things We Normally Forget

Percent of people who experience each of the following even though they didn’t have a head injury:

• Forget telephone numbers 58% • Forget people’s names 48% • Forget where car was parked 32% • Lose car keys 31% • Forget groceries 28% • Forget why they entered a room 27% • Forget directions 24% • Forget appointment dates 20% • Lose wallet or pocketbook 17% • Forget content of daily conversations 17%

Has This Happened to You?

General Rehabilitation Approaches

Restoration of damaged functions

Optimization of residual functions

Compensation for lost functions

Restoration of Damaged Functions

Targets underlying impairmentAttempts to restore/heal damaged

memoryTypical techniques:• Repetition• Practice (distributed better than massed)• Overlearning

Optimization of Residual Functions

Targets underlying impairmentAttempts to retrain normal memoryTypical techniques:• Chunking • First letter cueing• Imagery and association•Mental organization

Compensation for Lost Functions

Targets functional deficitsAttempts to bypass memory deficitsTypical techniques:• Labels/ lists• Notebooks/diaries/calendars• Alarms/timers• Electronic organizers

STIMULATION VS. OVERSTIMULATION

The first is good, but the second can be bad.

IF ONLY IT WAS THIS EASY

MEMORY IMPROVEMENT

• It’s not necessary to remember everything• There are advantages to forgetting • Prioritize – Focus on what you need to

remember and for what purpose. Decide which things:Need your immediate attentionCan be put on the “back burner” for laterCan simply be deleted (like “junk mail”)

GENERAL MEMORY IMPROVEMENT STRATEGIES

• Reduce the “obstacles” mentioned previously• Use Repetition• Use Repetition• Be physically organized (e.g., use bookmarks,

filing systems; keep important things in a predictable place)

• Use “External” memory aids (e.g., cell phones, lists, sticky notes, alarms, Day Timer, pill organizers, other people)

More is Not Always Better

GENERAL MEMORY IMPROVEMENT STRATEGIES

• “Internal” memory aids – make things personally meaningful, and link them with what you already know – active approach to improving memory. Some examples:

ChunkingFirst Letter CueingImageryMental Organization

CHUNKING

• Short-term memory typically can retain between 5 & 9 “chunks”

• “Chunk” = a meaningful unit of information – can be small or relatively large

• Group material into segments that are easier to remember

CHUNKING “The boy in the red shirt kicked his mother in the shin.”– Contains 12 words & 43 letters– Easier to remember if we reduce it to 3 “chunks”• “The boy in the red shirt…”• “kicked his mother…”• “in the shin.”

“2 5 3 9 6 8 0 6 0 6”– Contains 10 digits– Easier to remember if we reduce it to 3 “chunks”• (253) 968- 0606

FIRST LETTER CUEING• Good for remembering sequences

• “ROY G BIV “ = ROY G BIV – colors of the spectrum

• Fire Extinguisher “P A S S”• Pull pin; Aim hose; Squeeze handle; Sweep from

side to side

• Grocery Items: Chicken + Basil + Shrimp = “CBS”

IMAGERY• Make “mental pictures” – e.g., to link pairs of words

together, such as “apple” and “lightbulb,” or “dollar” and “snake”

• Can involve senses other than visual – e.g., songs

• “Method of Loci” -- visual imagery method using place with which you are familiar to “attach” things to remember – e.g., remembering shopping list by walking through your house

Can You Remember These Names?

• Ruby Farmer

• Liz Woodson

• Nick Rollins

• Russ Browning

MENTAL ORGANIZATION

• Planning

• Outlining

• Using categories and subcategories

Try to remember the following list by organizing it into categories:

• Motorcycle• Dump truck• SUV• Bus• Rickshaw • Jet plane • Compact car • Bicycle

“S Q 3R”

Method for learning and remembering new material

Survey, Question, Read, Recite, Review

Especially useful for academic coursework

Take-Home Points

• Memory is not perfect but it can be improved

• Don’t waste time on things that don’t need to be remembered

• Work your brain (but not too much)• If obstacles to memory are reduced, your

memory will improve

Take-Home Points (Cont.)

• Try to get information from short-term memory into long-term memory

• Try to link new learning to old learning• Use all 3 rehabilitation approaches–Restoration (e.g., repetition & practice)–Optimization (e.g., chunking & imagery)–Compensation (e.g., lists & electronics)

QUESTIONS?